The first point to make is that most insurers have signed up to the voluntary Rehabilitation Code which is designed to help the injured claimant makes as quick and as thorough a recovery as possible. The beneficial effect of this for the defendant’s insurance company (or ‘compensator’) is to stop compensation costs escalating.
It works by encouraging the claimant’s solicitor and the compensator to collaborate. Therefore, providing the compensator is happy to operate under the principles of the Code (and most are) it is unlikely that the cost of any rehabilitation services will come out of any compensation due to the claimant and nor is it likely to be repaid if the case is not settled in the claimant’s favour.
The process of rehabilitation
The purpose of the Code is to help the injured person (the claimant) to recover as quickly as possible so they can resume the same quality of life they enjoyed before the accident, including being able to go back to work. Although insurers are not legally required to invoke the Code they must consider using it for all personal injury claims.
If you have been injured, your lawyer will discuss your rehabilitation needs with the compensator as soon as is practically possible. The compensator will then commission a medical report, carried out by an independent, medical practitioner, which will recommend what action needs to be taken. If you, as the claimant, are happy with the recommendation, then you can proceed with the treatment and the cost will be covered directly by the insurance company. If you, after taking medical advice, consider that you need additional treatment over and above that recommended in the report, and it is considered reasonable, then your lawyer will claim for the cost of this on top of the basic provision. Such claims can cover complementary treatment such as acupuncture. The timing of the report and the acceptance of the recommendations are important: the emphasis is on early intervention to ensure that you have the best chance of recovery possible.
Does it matter how severe my injury is?
The Code covers both minor and more serious injuries and recognises that both require different levels of treatment. For less severe injuries (where the compensation is likely to be under £25,000) an initial rehabilitation assessment is carried out by someone with the appropriate qualifications (usually a nurse or occupational therapist) either face to face or by telephone. The subsequent report will recommend what sort of treatment is required and it is up to you to decide whether or not to proceed. If you do go ahead, the compensator will pay for it. By the same token, if you undergo treatment which the compensator believes is disproportionate in terms of cost or scope (bearing in mind the medical report) they are not obliged to pay for it.
If you suffer significant injuries then there may well be a need to engage a Case Manager, who will be an independent, appropriately qualified person (usually a professionally qualified medical practitioner) to oversee your case and treatment, liaising with the your solicitor and with the compensator. The Case Manager will carry out an Immediate Needs Assessment (INA) to establish the extent of your injuries and the required treatment programme. The INA might also recommend further medical investigations. On the assumption that the compensator agrees with the recommendations in the INA, treatment can proceed (although in cases of severe injury treatment will already be underway and the compensator will simply approve treatment retrospectively). If the compensator approves treatment under the Code but your claim against them ultimately fails, the compensator cannot claim back the cost from you.
It is in everyone’s best interest to address the medical needs of someone who has been injured through no fault of their own. The purpose of the Code is to help restore claimants to full health as soon as possible by encouraging collaboration between both sides and to keep costs from spiralling out of control. If you have any queries or concerns about paying for rehabilitation, please get in touch to discuss the available options.